Provider Demographics
NPI:1043287972
Name:STEVENS, MARK (D C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4339
Mailing Address - Country:US
Mailing Address - Phone:605-665-8365
Mailing Address - Fax:605-665-8365
Practice Address - Street 1:327 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4339
Practice Address - Country:US
Practice Address - Phone:605-665-8365
Practice Address - Fax:605-665-8365
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
S86513Medicare PIN
T66552Medicare UPIN